Pathology of the thyroid gland Flashcards
hyperthyroidism: symptoms and signs
- hypermetabolism
- enhanced EPI effect
- lid lag - delay in downward movement of upper eyelid
- ATRIAL FIBRILLATION
- thyroid storm
graves disease: pathophysiology
production of IgG antibody directed against TSH receptor called TSH receptor autoantibodies (TRAb)
graves disease: thyroid hormone levels
high T3
high T4
low TSH
patients presenting with myxedema must also present with what feature in order to have a diagnosis of HYPERthyroidism?
nodules
hyperthyroidism: thyroid gland gross appearance
diffuse, symmetrical beefy red gland
hyperthyroidism: histology
- hyperplastic follicles with papillary infoldings
- pale colloid with resportion vacuoles (“scalloping”)
definition: myxedema
it is USUALLY associated with what thyroid disorder?
accumulation of hyrophilic ground substance (amorphous gel-like substance) throughout the CT of the body
hypothyroidism
definition: cretinism
what are the distinctive features?
hypothyroidism presenting first in infancy or childhood
facial swelling puffy eyelids protruding tongue low hair line altered eyebrows
screening for hypothyroidism must occur before what time period?
3rd week
definition: hashimoto thyroiditis
chronic progressive thyroid disease - deficiency in Treg cells
increase in cytotoxic T cells and activated B cells
pathogenesis: hashimoto thyroiditis
HLA Dr5 (check recording)
gross appearance: hashimoto
diffusely enlarged
histology: hashimoto
- mononuclear inflammatory infiltrates
- well developed germinal centers
- thyroid follicles are atrophic and are lined in many areas by epithelial cells distinguished by the presence of Hurthlecells
Hurthle cells
- abundant eosinophilic granular cytoplasm
- metaplastic response of the normally low cuboidal follicular epithelial cells to ongoing injury
de quervain thyroiditis: definition and symptoms
secondary to a viral infection by mumps, adenoviruses, echo, coxsackie
- painful 40-50 yo, F/M 4:1
- acute febrile onset with acute enlargement of the gland
- increased ESR
- transient increase in T3/T4 and decrease in TSH
- transient hyperthyroidism weeks to months self resolves
de quervain thyroiditis: pathology
granulomas with giant cells, macrophages, lymphocytes, and destroyed thyroid follicles
multinodular goiter: pathology
- colloid rich follicles of varying sizes with FLATTENED epithelium
- nodules, hemosiderin, hemorrhage, calcification
thyroid tumors: cold nodules
palpable mass lesions that failr to take up radiolabeled iodine during nuclear scans
thyroid tumors: hot nodules
palpable mass lesions that are hyperfunctioning and accumulate increased amounts of radioiodine relative to surrounding normal during scan
thyroid adenoma
is it malignant or benign?
solitary, spherical encapsulated lesino that is demarcated from surrounding thyroid parenchyma by a well defined intact capsule
always benign, no chance to turn malignant
thyroid cancer: tumor type prevalence and prognosis
papillary - 65% - great
follicular - 25% - 50/50
medullary - 5% - 50/50
anaplastic - 5% - high mortality
papillary adenocarcinoma: gross appearance and histology
fibrovascular stalk with tumor cells
- orphan annie eye nuclei (marginated chromatin and optically clear centers - fixation artifact)
- psammoma bodies
- intranuclear cytoplasmic inclusion (INCI) aka nuclear hole
nuclear grooves aka coffee bean nucleus
follicular thyroid carcinoma
more aggressive
medullary thyroid carcinoma
cancer of differentiating C cells
RET protooncogenes
